Insomnia

Insomnia is a persistent disorder that can make it hard to fall asleep, hard to stay asleep or both, despite the opportunity for adequate sleep. With insomnia, you usually awaken feeling unrefreshed, which takes a toll on your ability to function during the day. Insomnia can sap not only your energy level and mood but also your health, work performance and quality of life.

How much sleep is enough varies from person to person. Most adults need seven to eight hours a night.

Many adults experience insomnia at some point, but some people have long-term (chronic) insomnia. Insomnia may be the primary problem, or it may be secondary due to other causes, such as a disease or medication.

You don't have to put up with sleepless nights. Simple changes in your daily habits can often help.

SYMPTOMS
Insomnia symptoms may include:

Difficulty falling asleep at nightAwakening during the nightAwakening too earlyNot feeling well rested after a night's sleepDaytime tiredness or sleepinessIrritability, depression or anxietyDifficulty paying attention, focusing on tasks or rememberingIncreased errors or accidentsTension headachesDistress in the stomach and intestines (gastrointestinal tract)Ongoing worries about sleep

Someone with insomnia will often take 30 minutes or more to fall asleep and may get only six or fewer hours of sleep for three or more nights a week over a month or more.

When to see a doctor

If insomnia makes it hard for you to function during the day, see your doctor to determine what might be the cause of your sleep problem and how it can be treated. If your doctor thinks you could have a sleep disorder, you might be referred to a sleep center for special testing.

CAUSES
Common causes of insomnia include:

Stress. Concerns about work, school, health or family can keep your mind active at night, making it difficult to sleep. Stressful life events — such as the death or illness of a loved one, divorce, or a job loss — may lead to insomnia.Anxiety. Everyday anxieties as well as more-serious anxiety disorders, such as post-traumatic stress disorder, may disrupt your asleep. Worry about being able to go to sleep can make it harder to fall asleep.Depression. You might either sleep too much or have trouble sleeping if you're depressed. Insomnia often occurs with other mental health disorders as well.Medical conditions. If you have chronic pain, breathing difficulties or a need to urinate frequently, you might develop insomnia. Examples of conditions linked with insomnia include arthritis, cancer, heart failure, lung disease, gastroesophageal reflux disease (GERD), overactive thyroid, stroke, Parkinson's disease and Alzheimer's disease.Change in your environment or work schedule. Travel or working a late or early shift can disrupt your body's circadian rhythms, making it difficult to sleep. Your circadian rhythms act as an internal clock, guiding such things as your sleep-wake cycle, metabolism and body temperature.Poor sleep habits. Poor sleep habits include an irregular sleep schedule, stimulating activities before bed, an uncomfortable sleep environment, and use of your bed for activities other than sleep or sex.Medications. Many prescription drugs can interfere with sleep, including some antidepressants, heart and blood pressure medications, allergy medications, stimulants (such as Ritalin), and corticosteroids. Many over-the-counter (OTC) medications — including some pain medication combinations, decongestants and weight-loss products — contain caffeine and other stimulants.Caffeine, nicotine and alcohol. Coffee, tea, cola and other caffeine-containing drinks are well-known stimulants. Drinking coffee in the late afternoon and later can keep you from falling asleep at night. Nicotine in tobacco products is another stimulant that can cause insomnia. Alcohol is a sedative that may help you fall asleep, but it prevents deeper stages of sleep and often causes you to awaken in the middle of the night.Eating too much late in the evening. Having a light snack before bedtime is OK, but eating too much may cause you to feel physically uncomfortable while lying down, making it difficult to get to sleep. Many people also experience heartburn, a backflow of acid and food from the stomach into the esophagus after eating, which may keep you awake.

Insomnia and aging

Insomnia becomes more common with age. As you get older, you may experience:

A change in sleep patterns. Sleep often becomes less restful as you age, and you may find that noise or other changes in your environment are more likely to wake you. With age, your internal clock often advances, which means you get tired earlier in the evening and wake up earlier in the morning. But older people generally still need the same amount of sleep as younger people do.A change in activity. You may be less physically or socially active. A lack of activity can interfere with a good night's sleep. Also, the less active you are, the more likely you may be to take a daily nap, which can interfere with sleep at night.

A change in health. The chronic pain of conditions such as arthritis or back problems as well as depression, anxiety and stress can interfere with sleep. Older men often develop noncancerous enlargement of the prostate gland (benign prostatic hyperplasia), which can cause the need to urinate frequently, interrupting sleep. In women, menopausal hot flashes can be equally disruptive.

Other sleep-related disorders, such as sleep apnea and restless legs syndrome, also become more common with age. Sleep apnea causes you to stop breathing periodically throughout the night. Restless legs syndrome causes unpleasant sensations in your legs and an almost irresistible desire to move them, which may prevent you from falling asleep.

More medications. Older people typically use more prescription drugs than younger people do, which increases the chance of insomnia caused by a medication.

Sleep problems may be a concern for children and teenagers as well. However, some children and teens simply have trouble getting to sleep or resist a regular bedtime because their internal clocks are more delayed. They want to go to bed later and sleep later in the morning.

COMPLICATIONS
Sleep is as important to your health as a healthy diet and regular exercise. Whatever your reason for sleep loss, insomnia can affect you both mentally and physically. People with insomnia report a lower quality of life compared with people who are sleeping well.

Complications of insomnia may include:

Lower performance on the job or at school,Slowed reaction time while driving and higher risk of accidents,Psychiatric problems, such as depression or an anxiety disorder,Overweight or obesity,Irritability,Increased risk and severity of long-term diseases or conditions, such as high blood pressure, heart disease and diabetes,Substance abuse

DIAGNOSIS
In addition to asking you a number of questions, your doctor may have you complete a questionnaire to determine your sleep-wake pattern and your level of daytime sleepiness. You may also be asked to keep a sleep diary for a couple of weeks if you haven't already done so.

Your doctor will likely do a physical exam to look for signs of other problems that may be causing insomnia. Occasionally, a blood test may be done to check for thyroid problems or other conditions that can cause insomnia.

If the cause of your insomnia isn't clear, or you have signs of another sleep disorder, such as sleep apnea or restless legs syndrome, you may need to spend a night at a sleep center. Tests are done to monitor and record a variety of body activities while you sleep, including brain waves, breathing, heartbeat, eye movements and body movements.

TREATMENT
Changing your sleep habits and addressing any underlying causes of insomnia, such as medical conditions or medications, can restore restful sleep for many people. If these measures don't work, your doctor may recommend medications to help with relaxation and sleep.

Behavior therapies

Behavioral treatments teach you new sleep behaviors and ways to improve your sleeping environment. Good sleep habits promote sound sleep and daytime alertness. Behavior therapies are generally recommended as the first line of treatment for people with insomnia. Typically they're equally or more effective than sleep medications.

Behavior therapies include:

Education about good sleeping habits. Good sleep habits include having a regular sleep schedule, avoiding stimulating activities before bed, and having a comfortable sleep environment.Cognitive behavioral therapy. This type of therapy helps you control or eliminate negative thoughts and worries that keep you awake. It may also involve eliminating false or worrisome beliefs about sleep, such as the idea that a single restless night will make you sick.Relaxation techniques. Progressive muscle relaxation, biofeedback and breathing exercises are ways to reduce anxiety at bedtime. These strategies help you control your breathing, heart rate, muscle tension and mood.Stimulus control. This means limiting the time you spend awake in bed and associating your bed and bedroom only with sleep and sex. Sleep restriction. This treatment decreases the time you spend in bed, causing partial sleep deprivation, which makes you more tired the next night. Once your sleep has improved, your time in bed is gradually increased.Remaining passively awake. Also called paradoxical intention, this treatment for learned insomnia is aimed at reducing the worry and anxiety about being able to get to sleep by getting in bed and trying to stay awake rather than expecting to fall asleep.Light therapy. If you fall asleep too early and then awaken too early, you can use light to push back your internal clock. You can go outside during times of the year when it's light outside in the evenings, or you can get light via a medical-grade light box.

Prescription medications

Taking prescription sleeping pills — such as zolpidem (Ambien), eszopiclone (Lunesta), zaleplon (Sonata) or ramelteon (Rozerem) — may help you get to sleep. Doctors generally don't recommend relying on prescription sleeping pills for more than a few weeks, but several medications are approved for long-term use.

Over-the-counter sleep aids

Nonprescription sleep medications contain antihistamines that can make you drowsy. Antihistamines may initially make you groggy, but they may also reduce the quality of your sleep, and they can cause side effects, such as daytime sleepiness, dizziness, urinary retention, dry mouth and confusion. These effects may be worse in older adults. Antihistamines also can worsen urinary problems, causing you to get up to urinate more during the night.